Provider Demographics
NPI:1376807750
Name:MILLER, MELISSA KELLI
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KELLI
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 GRAN PASEO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7921
Mailing Address - Country:US
Mailing Address - Phone:407-965-8889
Mailing Address - Fax:
Practice Address - Street 1:672 GRAN PASEO DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7921
Practice Address - Country:US
Practice Address - Phone:407-965-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist